Want to hear something shocking? According to the American Journal of Clinical Medicine (Winter 2009 issue) after assessing past statistics then projecting them forward, they predicted that if you fly in a HEMS helicopter and do that job for twenty years, you face a 40 percent chance of losing your life.

Since that article appeared, the following year there were six HEMS accidents claiming 16 more lives. The next year, 2011, two HEMS accidents occurred claiming the lives of six more. So far, this year, 2012, we’ve been lucky. There have been no HEMS accidents or fatalities, the longest stretch without an accident in years. I am personally holding my breath hoping the current trend continues.

For 33 years I have watched in despair as the industry grew into the deadly entity it is today, branded the most dangerous job in America. You see, I was one of the early pioneers in what was then a new and exciting industry, using skills I had learned as a combat helicopter pilot in Vietnam carrying wounded soldiers in my helicopter from the battlefields to surgical hospitals in an effort to save their young lives. What was originally a good idea quickly turned deadly. Here is how it happened. More importantly, from what I’ve seen in 33 years while flying abroad, I have the definitive answer to achieve safety in the US HEMS industry today.

IN THE BEGINNING

In 1972 the idea to use helicopters to save lives in America was taken from the battlefields of Korea and Vietnam to the skies over America. In doing so we unwittingly transplanted one war zone to create another. It must be a war zone, because the Air Medical Memorial is scheduled to open June 2013 near Denver, Colorado (airmemdicalmemorial.com). The memorial will have the names inscribed on granite walls honoring more than 350 men and women who have died in a medical helicopter crash. There will be a bronze sculpture of a typical flight crew nearby comprising a pilot and two medical personnel. Blank panels are designed to accommodate more names as necessary. If you have seen the Vietnam Memorial, doesn’t it sound hauntingly familiar?

My HEMS career began in January 1979. I was one of six ex-Vietnam helicopter pilots employed by Rocky Mountain Helicopters to fly on the Life Flight program at Hermann Hospital in Houston, Texas. We worked 3-day shifts at the hospital and were told we must get airborne in 5-minutes or less, day or night. We were eager to prove to a doubting American public and skeptical medical community that there was indeed a niche for a medical helicopter in the Emergency Medical Services (EMS) system. But that mindset came at a terrible price. It became dangerous. It quickly became apparent we were losing the decisions made in the cockpit as they became second-guessed by the medical side. This spawned a dangerours legacy still pervasive today.

We six pilots were instructed by our employer, Rocky Mountain Helicopters, that no matter what the weather, unless it was zero-zero, we had to take off from the hospital helipad to demonstrate to ‘the customer’ that we were at least trying. Soon we felt the influence of the hospital administration pressuring our company and us to make decisions we normally would not have made, like continuing a mission in poor weather or disregarding federal duty time regulations to save on the cost of hiring additional pilots to share the grueling workload.

One pilot did elect to fight back. One night, when he became so tired he felt unsafe to fly, he turned off his radio and beeper, told the hospital he was tired and went to bed. The hospital reported to Rocky Mountain that they had an ‘uncooperative’ pilot. The administration at Rocky Mountain, rather than backing up the pilot’s decision, fired him on the spot and sent a replacement the next day. That event came as a huge wake up call for the rest of us. Keep your mouth shut, appease the hospital personnel at any cost or risk termination. Establishing that mind-set was a fatal milestone in the history of HEMS, a mind-set still pervasive today according to HEMS pilots I have spoken to recently.

When Hermann Hospital’s Life Flight program began in 1976 it was only one of two hospital-based HEMS programs in America. We six pilots manned three Alouette III helicopters 24/7, operating from the hospital covering a 150-nautical mile radius catchment area. Today, there are more than 900 HEMS helicopters operating country-wide which has become a huge part of the current problem, a problem I will address later.

Even though we were tired and busting our duty times set out by federal regulation and not enforced by the FAA or Rocky Mountain, it did not take long for the HEMS concept to be proven and accepted by the medical community, the general public and the first responders, those first to the scene of an accident. It was a win-win situation for everyone concerned and had more to do with fattening the bottom line than for philanthropic reasons.

By leasing three helicopters from Rocky Mountain Helicopters, the hospital was able to cast a wider net to catch patients it normally wouldn’t have caught. One hospital administrator would later call such patients, “Golden Trout.” The helicopter was not unlike a courtesy car bringing in the sick and injured. The patients we carried were usually near-death, generating huge medical bills to fatten the hospital’s bottom line, something not lost on other hospital administrators across the country.

Although we pilots were dog-tired working the grueling 72-hour shifts and flying in weather we had no business flying in, while working for a helicopter operator who pandered to the hospital’s every whim, we were still relatively content because we were doing something we loved, flying helicopters and saving lives in the process. In addition, we now had a stable home life in the city, not flying in the bush away from family, like most helicopter flying jobs at the time.

We pilots soon began to notice hospital administrators arriving from all over the country to visit Hermann Hospital to assess if a hospital-based helicopter program would work for their institution too. So, by default, as the HEMS concept was so new, Hermann Hospital became the training base for new pilots who would set up these new programs. Like passing along a bad gene, the same policies and procedures and attitudes we followed were spread further afield.

A year later I was sent to set up a Life Flight program at the University of California, San Diego. In the five years I worked there, I flew four aircraft all chosen not by a pilot, but by the medical director. I flew the Bell Long Ranger, the Alouette III, the BO-105 and the Bell 222. Flying the Bell 222 single pilot IFR, we became the first hospital-based IFR program in America.

In the five years I worked in San Diego, twelve HEMS helicopters crashed in other programs across America killing 32 people. I noticed that the common denominator in nearly every fatal crash involved a single pilot who was not instrument rated getting caught in bad weather.

I was also not immune to nearly losing my life. Twice I went inadvertent IMC at night. I could have easily died on three other occasions unrelated to weather when on final approach to a perfectly laid out flare pattern at night, set up by well-meaning first responders, I noticed at the last minute criss-crossed wires over the landing zone that had been missed by those on scene.
TRYING TO STUFF THE GENIE BACK INTO THE BOTTLE

I left HEMS after five years in San Diego to take a job flying in the Sultanate of Oman for the Royal Oman Police and to set up a country-wide HEMS system there. In Oman I would have an epiphany. Nearly all the pilots there were British, having received their training in the Royal Air Force, Royal Navy or Royal Marines. Every one of them had flown IFR operations in the North Sea using two-crew. Flying with them gave me a different perspective, a different way of doing things, and a much safer way of doing things by flying two crew who were instrument rated and current.

As my way to try to stem the terrible trend in accidents and the senseless loss of life in HEMS back home, I wrote my first book entitled The Golden Hour to highlight the unsafe attitudes and practices I witnessed when I worked there. I wrote that book in 1985 for one purpose and one purpose only, to sound the alarm back home that if they continued on that same path, more people would die. In the end my efforts failed. Sadly, that book has become prophetic, like gazing into a crystal ball predicting things to come.

In the 13 years I flew in the Sultanate of Oman I watched the HEMS industry back home become more deadly. In that thirteen years, sixty crashes occurred, most of them the same crash scenario over and over again: controlled flight into terrain, CFIT, due to the non-rated instrument, single-pilot going inadvertent IMC, causing a total of 90 crewmembers to lose their lives.

Mike Burke, another former Vietnam helicopter pilot who I had flown with in Houston, wanted to do something to stop the terrible accident rate by bringing back the voice of reason from the cockpit. So along with HEMS pilots Don Wright and Tom Einhorn he founded the National EMS Pilot’s Association (NEMSPA) in 1985.

The three men launched a quest to try to make the HEMS industry a safe place to work. To try to garner support, Mike Burke allowed himself to be interviewed by Peter Van Sant in 1986 on the popular American television program 60 Minutes. With his voice altered and his face blacked-out, Mike listed the problems in the industry: decisions scrutinized by the hospital personnel, helicopter operators pandering to the hospital, an apathetic and ineffectual FAA and NTSB, and tired pilots flying single-pilot with no IFR training. Mike’s interview on 60-Minutes won Van Sant an Emmy Award, but sadly nothing changed in the HEMS industry.

Unwilling to give up, Mike was invited by Al Gore, who was then on the Senate Subcommittee for Aviation Safety, to give testimony to Congress on the subject. Again nothing changed in the industry, and the slaughter continued unabated.
From 1985 to 2011, the timeframe when I tried to get the word out through my book The Golden Hour and Mike’s efforts through the television broadcast on 60 Minutes and testimony before Congress, 336 more HEMS crews and several patients perished leaving 587 crash survivors.

The year 2008 was the worst year ever for HEMS helicopter crashes in America. Twenty-nine people lost their lives in thirteen HEMS crashes that year prompting the NTSB to finally proclaim the HEMS accident rate was ‘unacceptable’ and called a four-day hearing on the subject. The NTSB then asked the FAA to draft a Proposed rulemaking paper to offer solutions to the problem.

THE UNDERLYING REASON FOR SO MANY CRASHES

When one dissects the root problem as to why America has such an abysmal HEMS safety record, it boils down to one thing. It’s the 500-pound bacterium in the emergency room that everyone knows is there but ignores—GREED.
As one very experienced HEMS pilot put it, “It’s capitalism doing it’s thing.”

Medicare, the governmental agency that pays the medical bills for any HEMS flight, has become a major part of the problem. In 2002, Medicare changed its reimbursement rates, paying a 50-percent premium for what they termed ‘rural’ flights, to the tune of $225 million a year to ferry patients. This change in fee structure spawned even more greed to flourish among helicopter operators who were anxious to get in on the action. It created a feeding frenzy.

Helicopter companies sprung up everywhere investing millions in helicopters to collect the big payday doled out by the government, causing Medicare payments to skyrocket. Now, even Mom and Pop can purchase a Jet Ranger, outfit it with medical gear, hire a pilot and medical staff to crew it and receive as much as $16,000 for one flight.

Because there is no legislation regulating minimum standards for HEMS helicopters, operators are downsizing to cut costs, replacing twin-engine helicopters with single-engine helicopters as a way to realize greater profit. What incentive is there for an operator to pay for all the gear when one can just as easily get away with doing it on the cheap?

With so many helicopters out there, something called ‘helicopter shopping’ has added to the death toll as well. A call for a helicopter will come in to a central dispatcher. That dispatcher will call a program and ask the pilot there if he can take the flight. If the pilot refuses, determining the weather is too bad, the dispatcher will call another program until he finds a pilot who will take the flight, but he will not tell that pilot that other pilots turned down the flight due to weather.

In that four-day safety meeting in 2009, the NTSB and FAA determined that the industry cannot self regulate. And why should operators spend money on equipment when they are not forced to do so? Greed will time and again trump safety when allowed to do so.

THE SOLUTION

I agreed with Mike Burke when he said, “The system in the States is broken.”

The fix? As I said recently during my keynote address in St. Louis at the AAMS air medical conference, “The solution is easy.” I told the audience, “When you become tired of burying your flight crews due to these senseless, ongoing accidents the answer is this: The only way to ‘fix’ the system is through tough government regulation. “

There is no reason to reinvent the wheel because the answer is already out there. To do it right, look to Canada or to countries in Europe, like Germany or Switzerland which have stellar safety records. They mandate that any HEMS operator who wants to operate in their airspace must use Category A certified twin-engine helicopters, with two-member crews who are instrument rated and current. Or, at the very minimum, an autopilot must be installed if flying single pilot. Often, night vision goggles are also mandated, along with prohibiting night landing at sites that have not been checked out during the day. And finally, non-aviators (medical directors, hospital administrators, medical crews, et al.) should be locket out of the cockpit.

Radical change is needed to stop the bloodshed. Stricter regulation will affect the bottom line of many operators in the United States but the question must be asked, “How much is a human life worth?” That is the question I asked the 700 or so people in the audience that morning at the AMTC aeromedical conference in St. Louis. I can only hope my message was received loud and clear by the regulators who have the power to make it happen.